Contact Ulcer and Granuloma Intubation Granuloma

The depth of the ulcers may vary from superficial to deep lesions extending down to the perichondrium of the arytenoid cartilage. The localised necrosis of the epithelial and subepithelial tissue triggers an acute inflammatory reaction, with proliferation of granulation tissue initially infiltrated by neutrophils and later by macrophages, lymphocytes and plasma cells (Fig. 7.7b) . The marginal epithelium starts to proliferate, some regenerative atypia of epithelial cells, such as plump nuclei, and increased mitoses may be present [217, 383].

An exuberant proliferation of granulation tissue forms an exophytic polypoid lesion. New vessels are characteristically arranged radially from the base to the fibrin-covered surface of the lesion. Approximately 1 week after the initial injury, connective cells and col-lagenous fibres become more abundant and finally the predominant elements in the granuloma, which in the end stage is entirely covered in squamous epithelium. The covering epithelium is usually considerably thickened due to hyperplasia of the prickle cell layer or, rarely, of the basal and parabasal layer [177, 180].

The basis of therapy in CU/CGs and hyperacidic granulomas is the elimination of causative factors, voice rest, voice re-education, dietary measures, prohibition of smoking and alcohol abuse, and medical therapy such as antacids, corticosteroids and vitamins [224]. IGs frequently do not require treatment due to their self-limiting nature. In refractory cases, surgical treatment is indicated, either microsurgery or CO2 laser [28].

Necrotising sialometaplasia (NS) is a rare, benign, self-healing inflammatory lesion involving the minor salivary glands, primarily of the hard palate. The lesion is discussed in detail in Chap. 5. Here, some specificities of the extremely rare appearance of NS in the larynx are presented [373, 380, 383]. According to previous reports [373, 380], as well as our own experience, NS occurs in the larynx secondary to trauma or concomitantly with other non-neoplastic or neoplastic lesions. The pathogen-esis is probably associated with ischaemia. Laryngeal NS appears in the supraglottic and subglottic regions where seromucinous glands are present as a deep ulcerative or submucosal nodular lesion. The most prominent histolog-ic characteristics that help to distinguish the lesion from various forms of laryngeal carcinomas are: preservation of the lobular architecture of the necrotic glandular islands, the appearance of epithelial-myoepithelial islands with smooth margins, no cellular atypia or occurrence of pathologic mitoses in the rest of the cellular part, and the retention of the lumina in preserved ductal formations. The appearance of surface pseudoepitheliomatous hy-perplasia may cause additional problems in differential diagnosis with laryngeal cancers, especially when frozen section analysis is performed. The duration of the healing process is related to the size of the lesion [380].

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